Research has shown that stress and other psychological factors can influence cancer outcomes.
Hans Selye, the father of stress research, defined stress as the body’s response to any demand, whether that be an actual external demand or an individual’s perception of demands, influenced by their coping abilities.1
Psychosocial stress is associated with a physiological stress response, characterised by increased secretion of stress hormones.2
Research suggests that long-term exposure to hormones like cortisol and the fight-or-flight hormones adrenaline and noradrenaline, which the body releases in response to stress, may promote tumour growth.3,4
Overactivation of the stress response may impair immune response5, while the release of stress hormones may impact DNA repair and tumour cell growth.6,7
Stress biomarkers can also trigger and maintain chronic inflammation2, which has been shown to play various roles in cancer promotion and progression.8
Stressed individuals are also more likely than stress-free individuals to smoke tobacco9, consume excessive amounts of alcohol10, and be obese11, all behaviours that are risk factors for cancer12,13 and are associated with chronic inflammation.14
Studies on the potential role of chronic psychological stress on cancer incidence have shown conflicting results, suggesting an indirect association between stress and cancer risk.15
Studies that showed an association between stress and cancer:
Studies that showed no association between stress and cancer:
There is some evidence that diet may provide some protection against the effects of stress.22 Studies looking at the Mediterranean style of eating show that a mostly plant-based diet improves resilience and reduces risk of anxiety and depression. Eating wholegrains, legumes, fruits, vegetables, nuts, seeds and healthy plant fats helps reduce risk of some mental health problems, including stress.
Since chronic stress has been linked with higher rates of tobacco use9 and alcohol10 consumption, both of which can increase your risk of cancer, finding healthier ways to manage stress can be beneficial.
Emotional and social support6 can help you better cope with psychological stress. Take time to cultivate your relationships with loved ones.
Try out relaxation techniques such as deep breathing, progressive muscle relaxation and prayer.
Exercise has been shown to effectively reduce stress levels and cancer risk.23
Healthy sleep is essential to better manage stress. Make it a priority. Aim for seven to eight hours per night.
Find professional support through counselling or psychotherapy.
Regardless of whether stress directly causes cancer, there’s no doubt that stress affects your overall health.
While research has not proven a cause-and-effect relationship between stress and cancer, people under stress may adopt certain behaviours, such as smoking, overeating (leading to obesity) or drinking alcohol, which increases a person’s risk for cancer. Finding new ways to manage stress through relaxation, exercise, eating well, adequate sleep and emotional support can be beneficial to reduce stress and lower the risk of cancer.
1. Selye H. The Stress of Life. New York: McGraw-Hill; 1956.
2. Hänsel A, Hong S, Cámara RJA, von Känel R. Inflammation as a psychophysiological biomarker in chronic psychosocial stress. Neurosci Biobehav Rev. 2010;35(1):115-121. doi:10.1016/j.neubiorev.2009.12.012
3. Ross K. Mapping pathways from stress to cancer progression. J Natl Cancer Inst. 2008 July 2;100(13):914-917. doi:10.1093/jnci/djn229
4. McEwen BS, Gray JD, Nasca C. Redefining neuroendocrinology: Stress, sex and cognitive and emotional regulation. J Endocrinol. 2015 Aug;226(2):T67-T83. doi:10.1530/JOE-15-0121
5. Reiche EMV, Nunes SOV, Morimoto HK. Stress, depression, the immune system, and cancer. Lancet Oncol. 2004 Oct;5(10):617-625. doi:10.1016/S1470-2045(04)01597-9
6. Lutgendorf SK, Sood AK, Anderson B, et al. Social support, psychological distress, and natural killer cell activity in ovarian cancer. J Clin Oncol. 2005 Oct 1;23(28):7105-7113. doi:10.1200/JCO.2005.10.015
7. Antonova L, Aronson K, Mueller CR. Stress and breast cancer: from epidemiology to molecular biology. Breast Cancer Res. 2011 Apr 21;13(2):208. doi:10.1186/bcr2836
8. Grivennikov SI, Greten FR, Karin M. Immunity, Inflammation, and Cancer. Cell. 2010 Mar 19;140(6):883-899. doi:10.1016/j.cell.2010.01.025
9. Heikkilä K, Nyberg ST, Fransson EI, Alfredsson L, De Bacquer D, Bjorner JB et al. Job strain and tobacco smoking: An individual-participant data meta-analysis of 166 130 adults in 15 european studies. PLoS One. 2012 July 6;7(7):e35463. doi:10.1371/journal.pone.0035463
10. Heikkilä K, Nyberg ST, Fransson EI, Alfredsson L, De Bacquer D, Bjorner JB et al. Job strain and alcohol intake: A collaborative meta-analysis of individual-participant data from 140 000 men and women. PLoS One. 2012;7(7):e40101. doi:10.1371/journal.pone.0040101
11. Nyberg ST, Heikkilä K, Fransson EI, Alfredsson L, De Bacquer D, Bjorner JB et al. Job strain in relation to body mass index: Pooled analysis of 160000 adults from 13 cohort studies. J Intern Med. 2012 Jul;272(1):65-73. doi:10.1111/j.1365-2796.2011.02482.x
12. Bagnardi V, Rota M, Botteri E, Tramacere I, Islami F, Fedirko V et al. Alcohol consumption and site-specific cancer risk: A comprehensive dose-response meta-analysis. Br J Cancer. 2015 Feb 3;112(3):580-593. doi:10.1038/bjc.2014.579
13. Botteri E, Iodice S, Bagnardi V, Raimondi S, Lowenfels AB, Maisonneuve P. Smoking and colorectal cancer: A meta-analysis. JAMA - J Am Med Assoc. 2008 Dec 17;300(23):2765-2778. doi:10.1001/jama.2008.839
14. Chida Y, Hamer M, Wardle J, Steptoe A. Do stress-related psychosocial factors contribute to cancer incidence and survival? Nat Clin Pract Oncol. 2008 May 20;5:466-475. doi:10.1038/ncponc1134
15. Blanc-Lapierre A, Rousseau MC, Parent ME. Perceived workplace stress is associated with an increased risk of prostate cancer before age 65. Front Oncol. 2017 Nov 13;7:269. doi:10.3389/fonc.2017.00269
16. Helgesson Ö, Cabrera C, Lapidus L, Bengtsson C, Lissner L. Self-reported stress levels predict subsequent breast cancer in a cohort of Swedish women. Eur J Cancer Prev. 2003;12(5):377-381. doi:10.1097/00008469-200310000-00006
17. Lillberg K, Verkasalo PK, Kaprio J, Teppo L, Helenius H, Koskenvuo M. Stressful life events and risk of breast cancer in 10,808 women: A cohort study. Am J Epidemiol. 2003;157(5):415-423. doi:10.1093/aje/kwg002
18. Schoemaker MJ, Jones ME, Wright LB, Griffin J, McFadden E, Ashworth A et al. Psychological stress, adverse life events and breast cancer incidence: A cohort investigation in 106,000 women in the United Kingdom. Breast Cancer Res. 2016;18:72. doi:10.1186/s13058-016-0733-1
19. Schernhammer ES, Hankinson SE, Rosner B, Kroenke CH, Willett WC, Colditz GA et al. Job stress and breast cancer risk: The nurses’ health study. Am J Epidemiol. 2004 Dec 1;160(11):1079-1086. doi:10.1093/aje/kwh327
20. Metcalfe C, Smith GD, Macleod J, Hart C. The role of self-reported stress in the development of breast cancer and prostate cancer: A prospective cohort study of employed males and females with 30 years of follow-up. Eur J Cancer. 2007 April;43(6):1060-1065. doi:10.1016/j.ejca.2007.01.027
21. Heikkila K, Nyberg ST, Theorell T, et al. Work stress and risk of cancer: Meta-analysis of 5700 incident cancer events in 116 000 European men and women. BMJ. 2013;346:f165. doi:10.1136/bmj.f165
22. Carvalho KMB, Ronca DB, Michels N, Huybrechts I, Cuenca-Garcia M, Marcos A, et al. Does the Mediterranean diet protect against stress-induced inflammatory activation in European adolescents? Nutrients. 2018 Nov;10(11):1770. doi: 10.3390/nu10111770
23. Moore SC, Lee IM, Weiderpass E, Campbell PT, Sampson JN, Kitahara CM, et al. Association of leisure-time physical activity with risk of 26 types of cancer in 1.44 million adults. JAMA Intern Med. 2016 Jun 1;176(6):816–25. doi: 10.1001/jamainternmed.2016.1548